Medical necessity reviews removed for SI injection prior authorizations

Beginning April 1, 2026, we’ll no longer require a medical necessity review as part of the prior authorization process for sacroiliac joint injection Healthcare Common Procedure Coding System (HCPCS) G0260 and CPT® code 27096. This change applies to UnitedHealthcare commercial and UnitedHealthcare Individual Exchange Plan members.

We’ll continue to require a site-of-service medical necessity review for CPT code 27096 and a site-of-service medical necessity review will be added to the prior authorization process for HCPCS code G0260.

Prior authorization details

We’ll still require prior authorizations for HCPCS code G0260 and CPT code 27096 for UnitedHealthcare commercial plans and UnitedHealthcare Individual Exchange Plans.

For UnitedHealthcare Community Plans in Kentucky and North Carolina, we’ll no longer require prior authorizations for CPT code 27096. There will be no changes to other UnitedHealthcare Community Plans.

How to submit and manage prior authorizations

• Sign in to the UnitedHealthcare Provider Portal with your One Healthcare ID
  • If you don’t have a One Healthcare ID, register now
• From the left-hand tabs, select Prior Authorizations & Notifications